Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

Abstract

One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT. Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed. The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly ( P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98). Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.

Does Posterior Cord Compression From the Ligamentum Flavum Influence Clinical Outcomes After Anterior Cervical Discectomy and Fusion?

“…It is one of the most commonly used approaches used to manage cervical myelopathy 4,5 . However, ACDF cannot address compressive structures located posterior to the spinal cord 6–10 . In the setting of lumbar spinal stenosis, it has been accepted that inserting anterior interbody devices could lead to indirect decompression, even when ligamentum flavum hypertrophy is substantial 11–13 .…”

“…4,5 However, ACDF cannot address compressive structures located posterior to the spinal cord. [6][7][8][9][10] In the setting of lumbar spinal stenosis, it has been accepted that inserting anterior interbody devices could lead to indirect decompression, even when ligamentum flavum hypertrophy is substantial. [11][12][13] Although several case reports and radiographic studies regarding ACDF and cervical myelopathy aggravated by the ligamentum flavum have been reported, the efficacy of anterior decompression in the setting of cord compression from the ligamentum flavum (CCLF) has not been characterized.…”